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WEDNESDAY, Feb. 6, 2013 — A new study projects there will be 13.8 million Americans living with Alzheimer's disease by 2050, up from 4.7 million in 2010. The study, published in the journal Neurology, indicates an outsized need to boost research efforts, develop innovative treatments, increase the caregiver workforce, and move toward finding a cure for the disease.

The risk for developing Alzheimer's disease increases as a person ages. And the anticipated ballooning of the number of people with Alzheimer's is due to increasing lifespans, and a sizable, aging baby boomer population of 78 million — 28 percent of the U.S. total — who are expected to live well past previous generations.

Currently, 1 in 8 Americans over the age of 65 has Alzheimer's disease, which is the sixth-leading cause of death in the United States, according to the Alzheimer's Association. Symptoms include inability to recognize people or objects, and difficulty with motor skills and speech.

According to the authors of the Neurology study, in 2010, there were 0.7 million people with Alzheimer's between 65 and 74 years old, 2.3 million between 75 to 84, and 1.8 million 85 and older. Among the estimated 13.8 million Alzheimer's patients in 2050, approximately half will be 85 or older, say the researchers.

The research team analyzed data from 1993 to 2011 on 10,802 African Americans and whites in Chicago who were 65 and older. They interviewed subjects every three years to screen for dementia, and then combined that information with U.S. Census Bureau death rate data and projected death rates.

"Without having these numbers we generated, it’s like knowing a hurricane is coming but not knowing what category it’s going to be in," says Jennifer Weave, ScD, assistant professor at the Rush Institute for Healthy Aging in Chicago and co-author of the study. "Its kind of like climate change. Until it stares you right in the face, it’s hard to really comprehend the magnitude of the problem."

Parsing and predicting these numbers wasn't an easy task, says Weave. The U.S. government does not keep count of the number of people with Alzheimer's like it does with diseases such as cancer or HIV. "Some research suggests that half of the people who have Alzheimer's don't know they have it," she says.

More Alzheimer's, Less Access to Care

In the 20th century, life expectancy increased steadily because of many factors, such as better medical treatment, vaccines, improved nutrition, and cleaner water, among others. In the year 1900, a typical American's average life expectancy was 49.2 years. By 1950, that number had increased to 68.1 years, and by 1975, to around 74, according to the National Centers for Health Statistics. In the past decade that number has risen to almost 78 years, according to the U.S. Centers for Disease Control (CDC). These figures alone speak volumes about just how overwhelmed our health care system may be in the coming decades.

Alzheimer's disease can be active for a decade or more, and as the disease progresses, a patient requires around-the-clock care, whether at home or in an assisted living or nursing home facility. Both routes for care tax not just a patient, but also their loved ones, explains Lou-Ellen Barkan, president and CEO of the Alzheimer's Association's New York City chapter. "People who become ill live a long time with the disease," says Barkan. "Most people cannot afford the kind of care we're talking about."

Alzheimer's is an incredibly costly disease. In 2012, the country spent $200 billion on Alzheimer's, according to a recent report from the Alzheimer's Association. As the United States works to reshape its health care system — expanding Medicaid and scaling down Medicare — the situation becomes more dire, she says. "This is going to bankrupt the system. We need to look at how money is being spent," she says."We do not have enough nursing homes, we do not have enough nursing home beds, and we don’t have enough people trained in care at these nursing homes."

In New York alone, experts predict that 1 out of 5 people will have Alzheimer's or be caring for someone with the disease within the next few decades, says Barkan. "I look around and I wonder where is everyone going to go? The real question is how will government pay for that care? That will play itself out in the next 5 to 10 years," she says.

Better Treatment and Preventive Care: Enough to Help an Epidemic?

In recent years, scientists have developed newer treatments for Alzheimer's, but there is no cure in sight. There are several medications on the market that work by stopping the breakdown of acetylcholine, a neurotransmitter that is believed to be important for cognition and memory. Drugs in this class include Aricept, Exelon, and Razadyne. Some recent research has looked into developing an Alzheimer's vaccine to prevent the disease.

Some medical experts who work closely with the aging population say it's essential to encourage preventive care. Zachary Palace, MD, a geriatrician and director of the Hebrew Home, a nursing home in Riverdale, N.Y., says he observes that residents who work to keep their brains sharp and stay busy by doing activities such as playing crossword puzzles, socializing, and staying physically active, tend to fare better and are less likely to develop dementia. "I think we need more emphasis on what we do know," says Dr. Palace.

Last year, President Barack Obama signed a bill that outlines a national fight against Alzheimer's disease initiative to develop effective treatments for the disease and related forms of dementia by the year 2025. Two trials underway at the National Institutes of Health, funded through Obama's plan, have shown promise. One is for an insulin nasal spray treatment, and the other is a large scale prevention trial involving people at high-risk for developing the disease.

"Research can also tell us which ways of managing Alzheimer's is most effective for caregivers," says Weave. "It’s possible we won’t figure out how to cure Alzheimer, but we may figure out how to manage it."

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